Health Tips

Aphthous mouth ulcers, also known as canker sores or aphthous stomatitis, are a common variety of ulcer that form on the mucous membrane of the mouth (oral cavity). It affects around 20 percent of the population, and it is more common in women than in men. Aphthous ulcers are generally round or oral in shape and form in soft areas of the mouth, such as inside of the lips, the cheeks or underside of the tongue. They are benign, non-contagious and can occur as single ulcers or multiple ulcers (in clusters). 

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Aphthous mouth ulcers are divided into 3 main types:

1. Minor aphthous ulcers (most common, up to 80% of aphthous ulcers cases)

• In clusters of 1 to 5, usually less than 10 mm in diameter

• White or yellowish-grey centre with an inflamed red outer edge

• Heal within 7 to 14 days without treatment

2. Major aphthous ulcers

• In clusters of up to 10

• Usually more than 10mm in diameter, and often coalesce to form one large ulcer

• Can persist for 6 weeks or longer and tend to heal with scarring

• Can be painful and make eating difficult

3. Herpetiform ulcers

• In clusters of up to 100

• 1 to 2 mm in diameter, coalesce to form larger ulcers

• Usually heal within a month

• Can be very painful

Causes

The causes of aphthous mouth ulcers are not well understood. It may also be partly genetic, with 40 percent of people who experience ulcers having a family history of the condition. There are also a number of possible precipitating or exacerbating factors, including:

• Trauma (inadvertent bite, eating rough or sharp food, ill-fitting dentures, injuries from toothbrushing, orthodontic braces)

• Hormonal factors (menstrual cycle)

• Emotional stress and lack of sleep

• Micronutritional deficiencies (iron, B12, or folate) or food allergies

• Infections

• Immunosuppression therapy

• Medications

Treatment

There is no cure for aphthous ulcers, but there are ways to manage the symptoms. In most of the cases, the ulcers will disappear without treatment.

• local corticosteroids, eg triamcinolone paste (Kenalog®) as symptom relief for mild-to-moderate ulcers

• local anaesthetics (eg lidocaine, benzocaine) or anti-inflammatory drugs (eg benzydamine) as temporary analgesia to relief pain

• protectants (eg Orabase® paste) stick to the mucosa and protect the ulcer from further abrasion.

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Home remedies and advices

• Rinse the mouth with salt water or non-alcoholic chlorhexidine mouthwash (to soothe the ulcers and hasten healing process)

• Apply ice chips or cubes on affected area to reduce swelling

• Avoid spicy, rough, or any irritating food that may trigger ulceration

• Focus on a healthy, balanced diet containing sufficient amounts of nutrients and vitamins

• Maintain good oral hygiene and use a soft toothbrush to avoid irritation

• Induce stress management strategies and get adequate sleep

Takeaway: Aphthous ulcers are common and can heal without treatment. If the symptoms cannot be managed, topical treatments can be obtained from pharmacies to help in relieving. However, if there is no improvement within 2 weeks despite appropriate treatment, you should consult a doctor to prevent further complication.

References:

1. https://amhonline-amh-net-au.ezproxy.lib.monash.edu.au/chapters/ear-nose-throat-drugs/drugs-mouth-throat-conditions/mouth-throat-conditions?menu=hints
2. https://www.dermnetnz.org/topics/mouth-ulcer/
3. https://ada.com/conditions/aphthous-ulcers/

Cover image credit: Medlife

Written by

Ms. Charlotte Lee